Table 3.

Summary of results showing barriers and facilitators for shorter time to diagnosis of breast cancer in low- and middle-income countries.

Study No.	Lead Author	Delayed Pre-contact Interval (days)	Delayed Post-contact Interval (days)	Barriers to early diagnosisa	Facilitators of early diagnosisa
1	Amornsak P et al. [15]	>90b	>90b	-Previous breast symptoms -Self-treatment -Longer distance from home to hospital (>5 km) -Longer travel time (>60 min) -Advanced stage -Early pregnancy (<20yrs) -Greater number of consultations before diagnosis (>2)
2c	Foerster M et al. [19]			-Older age (every 10 yrs older increases delay) -Low socioeconomic position -Illiterate or primary education only -Belief in traditional Medicine -HIV Positive	-Heard about BC -Think BC is common
3	Medeiros GC et al. [26]		>90	-Diagnosis/breast biopsy in public health service -Shorter interval to gynaecological consultation (<3years)	-Breast lump as first sign
4	Pace LE et al. [29]	>180b	>180b	-Illiterate or primary education only -First consultation with traditional healer -Visit of health facilities ≥5 times before diagnosis	-Place of residenced
5c	Togawa K et al. [30]	>90b	>90b	-Rural residence -Greater travel distance (every 50 km more increases delay)
6	Unger-Saldana K et al. [31]			-Being single -Interpret symptoms as not worrisome. -Concealed symptoms -Lack of financial resources -Difficulty missing a day at work. -Visited other health services than cancer hospital -Perceived medical errors
14	Dos Santos Andrade LS et al. [16]		>90	-Public health facility for diagnosis	-Integrated health services -Privately financed -Support from NGO.
15	Frie KG et al. [20]			-Lack of knowledge of breast-self-examination -Interpretation of first symptom as not serious -Being employed -Being married -Younger age
16	Hewage S et al. [21]			-First consultation with Ayurvedic doctor	-Initial presentation being to a specialist
17	Hewage SA et al. [22]	>15b	>30b	-Lower family income -Socioeconomically disadvantaged -Poor emotional support -Negative perception towards accessibility of health services -Lack of knowledge about BC -Multiple visits to the healthcare provider	-Initial presentation being to a specialist (Surgeon or Oncologist)
18e	Imran M et al. [24]			-Being married	-Being employed
19	Mohd Mujar NM et al. [28]	>90b	>30b	-Complementary and alternative medicine use	-Symptomatic breast lump
20	Daniel O et al. [34]			-Residence outside central Kenya -Never married/without partner -Women with three children or more
21f	Hanafi I et al. [35]	>90b	>90b	-Lack of accessibility of healthcare (smaller cities/rural residence, Insufficient income, lower education, armed conflict had direct relation with lack of accessibility)

NGO: Non-governmental organization; BC: Breast Cancer.

^aOnly the factors which are significant in multivariable analysis were included.

^bTime given in weeks/months converted to days.

^cFactors for total diagnosis time (from symptoms to diagnosis).

^dResidence compared to study area and other.

^eFactors for total time to treatment (symptom recognition to treatment).

^fFactors influencing any interval more than 90 days.